Head Trauma

Question 1

What is Diffuse axonal injury

Answer 1

Diffuse axonal injury (DAI) is the result of traumatic shearing forces that occur when the head is rapidly accelerated or decelerated. It results in injury of the axons at the interface between the grey and the white matter.

Question 2

Stages in Slowly accumulating Extradural hematoma

Answer 2

• Stage of Concussion.
• Stage of Lucid interval: in which the patient regains his consciousness after concussion and before it is lost once more in the stage of compression
• Stage of Compression.

Question 3

Describe Rapidly accumulating Extradural hematoma

Answer 3

the patients present with stage of compression Stage of compression:
* Signs of increased intracranial pressure: severe headache, vomiting and deterioration of the level of consciousness
* Signs of lateralization due to (Uncal herniation) :
- Ipsilateral dilated fixed pupil
- Ipsilateral conjugate eye deviation
- Contralateral hemiparesis
- Contralateral exaggerated reflexes and positive Babinski

Question 4

Indications for elevation of depressed fracture?

Answer 4

• Depression is > 1 cm
• Gross cosmetic deformity
• Wound infection or gross wound contamination
• Frontal sinus involvement
• Clinical or radiological evidence (CT) of dural penetration (CSF leak intradural pneumocephalus … etc.)
• Presence of significant intracranial hematoma

Question 5

Skull base fractures classification

Answer 5

Anterior cranial fossa fracture: C/P:
- Epistaxis, CSF rhinorrhea
- Subconjuntival hemorrhage, Raccon’s eyes (periorbital hematoma)
- Olfactory nerve affection

Middle cranial fossa fracture: C/P
- Bleeding per ear
- CSF otorrhea
- Affection of 7th and 8th cranial nerve

Posterior cranial fossa fracture: C/P
- Battle sign: bluish color behind the ear
- Brain stem affection
- atlanto axial subluxation

Question 6

Summarize glasgow coma scale

Answer 6

The 15 points GCS is the most commonly used neurologic injury severity scale for adults because of its high inter-observer reliability and generally good prognostic capabilities.
Eye Opening
Response
4-spontaneously
3-to speech
2-to pain
1-No response

Verbal Response
5-oriented to time, place and person
4-confused
3-inappropriate words
2-incomprehensible sounds.
1-no response

Motor Response
6-obeys commands
5-localizing pain
4-withdrwal to pain
3-abnormal flexion to pain
2-abnormal extension to pain
1-no response

Severity of TBI: It’s generally agreed that TBI with a GCS of 13 or above is considered to be mild, 9 – 12 is considered to be moderate and 8 or below is considered to be severe TBI.
NB: Intubation is mandatory if the GCS <8 as the patient will not be able to protect his airway.